Outcomes and pathologic response of primary lung cancer treated with tyrosine kinase inhibitor/immune checkpoint inhibitor before salvage surgery.

PURPOSE: Advances in primary lung cancer drug therapy have extended patients' survival, including patients with stage IV disease. This study assessed the safety and effectiveness of salvage surgery following tyrosine kinase inhibitor (TKI) or immune checkpoint inhibitor (ICI) therapy in primary lung cancer. METHODS: A retrospective chart review was conducted of 2050 primary lung cancer surgeries performed at our institution between 2012 and 2022. The study included patients who underwent salvage surgery for unresectable lesions that became resectable or localized residual lesions after treatment. We investigated patients' clinicopathological characteristics, therapeutic responses, and survival outcomes. RESULTS: We identified eight cases of salvage surgery after TKI treatment and eight cases after ICI treatment. Five patients experienced early recurrence after surgery; however, the long-term outcome in the post-TKI group was favorable, with a median overall survival (OS) of 66 (range: 28-80) months. Postoperative recurrence was confined to local lymph node recurrence in one patient in the post-ICI group. Despite the relatively short observation period, the long-term prognosis remained promising, with a median OS of 18.7 (range: 9.7-55.8) months. CONCLUSIONS: Salvage surgery after TKI or ICI treatment can be safely performed, and the OS may be favorable.

Unusual giant multilocular thymic cyst with mature teratoma including a carcinoid component in the mediastinum.

BACKGROUND: Teratoma is the second most common mediastinal neoplasm, but malignant transformation in mature teratomas is uncommon, and cases of carcinoid tumor with teratoma are described in only a few studies. In addition, multilocular thymic cyst associated with mature mediastinal teratoma is also a rare entity. There have been no reports of case with the coexistence of these three pathological lesions. CASE PRESENTATION: The patient was a 24-year-old man who was referred to our hospital due to a 2-day history of left shoulder pain, a feeling of severe chest tightness and high fever. Pre-operative computed tomography (CT) showed a large, fluid-filled and well-demarcated multilocular cyst in the anterior to superior mediastinum measuring up to 12 cm in size. Contrast-enhanced CT also revealed that the tumor contained a solid component with slight contrast enhancement and spotty wall-thickening septation. Therefore, cystic thymoma, thymic cyst, cystic teratoma, or germ cell tumor with an inflammatory reaction were considered as differential diagnoses. The patient underwent tumor extirpation under median sternotomy. The pathological diagnosis was multilocular thymic cyst with mature teratoma including carcinoid tumor (Grade 2) in the mediastinum. CONCLUSIONS: The relationship between thymic cyst, teratoma and carcinoid tumor is unclear at present; therefore, further research is needed to clarify the relationship between these entities. In this report, we present a case of multilocular thymic cyst with mature teratoma including a carcinoid component in the mediastinum that was detected by complete surgical resection.

Superior vena cava replacement combined with venovenous shunt for thymic carcinoma.

INTRODUCTION: Advanced-stage thymic malignancies are a heterogeneous group of mediastinal tumors that include thymoma and thymic carcinoma infiltrating the surrounding thoracic structures. When the tumor infiltrates the superior vena cava (SVC), radical resection can be selectively achieved via en bloc SVC resection and its prosthetic conduit replacement. We herein report a case of SVC replacement for thymic carcinoma en bloc radical resection. CASE PRESENTATION: A 75-year-old Japanese man presented at our hospital due to progressive dyspnea and edema of his face and upper extremities. CT showed a 55 × 40 × 38-mm tumor located at the anterior mediastinum lesion. This tumor had invaded the superior vena cava and both brachiocephalic veins. We performed surgical resection for the thymic carcinoma located at the mediastinum that invaded the superior vena cava and both brachiocephalic veins. The surgery was performed through a full median sternotomy and transmanubrial approach without using an artificial heart and lung. The tumor involved the SVC, right brachiocephalic vein (RBCV) and left brachiocephalic vein (LBCV). We performed SVC replacement for thymic carcinoma en bloc radical resection. DISCUSSION: This report has two important implications. First, a venovenous shunt (VVS) from the distal LBCV to the right auricle was very useful and safe before performing an SVC complete clamp. The second implication of our study was that using a PTFE with a large inner diameter may prevent thrombus occlusion. CONCLUSIONS: We experienced SVC replacement for thymic carcinoma en bloc radical resection. We were able to safely performed this surgery using our usual approach.

Two extremely rare cases of extrapleural hematoma.

BACKGROUND: Extrapleural hematoma is uncommon. However, according to the size of hematoma and/or the progression of anemia, surgical treatment to control bleeding might be necessary because a huge hematoma can cause ventilator and circulatory disturbances to press heart and lung. We present two unusual cases of huge extrapleural hematoma in an anticoagulated patient with no apparent history of trauma or otherwise traumatic episodes. CASE PRESENTATION: Case 1: A 78-year-old man presented to our emergency department with pain in his right shoulder and disturbance of consciousness. He had no apparent history of trauma. Computed tomography (CT) of the chest revealed the presence of a huge lens-like encapsulated lesion measuring 220 × 90 mm in the right thoracic cavity. These findings all supported a diagnosis of extrapleural hematoma with hemothorax. Case 2: A 73-year-old man was brought to our hospital by ambulance after bruising his back in his house. CT of the chest revealed the presence of a huge lens-like encapsulated lesion measuring 230 × 70 mm in the left thoracic cavity. Hemorrhagic effusion was obtained by thoracocentesis, and the lesion was suspected of being a hematoma. In both two cases, we performed video-assisted thoracic surgery (VATS), which was minimally invasive and effective. These two patients were cured and discharged smoothly after surgery. CONCLUSIONS: We reported two rare cases of extrapleural hematoma. This disease requires close attention when it manifests in patients undergoing anticoagulation therapy. Regarding treatment, VATS was particularly effective in these cases.